Sr. External Audit Specialist

Capital Blue Cross; United States; On-site; USD 90,000 - 150,000; Full time

Job summary

Capital Blue Cross is seeking an experienced audit professional to lead external audits, coordinate with regulators, and drive compliance across Capital's operations, including pharmacy workflows. The role requires deep knowledge of audit processes, exceptional organizational skills, and the ability to communicate effectively with senior leadership.

The position emphasizes managing complex audit projects, ensuring timely documentation, and guiding internal teams through audit cycles to meet

Qualifications

• Experience leading external audits and regulatory examinations.
• Ability to coordinate across multiple business units and with external auditors.
• Strong written and verbal communication; capable of presenting findings to senior leadership.

Responsibilities

• Plan, organize, and lead external audit projects including group benefit examinations and audits.
• Serve as primary liaison between external auditors and Capital operational areas.
• Track and manage audit deliverables ensuring timely completion and documentation.
• Provide training to internal teams on engaging with external auditors and addressing audit exceptions.
• Recommend and develop department policy and procedures to improve audit outcomes.
• Maintain relationships with external auditors and ensure adherence to Capital standards.

Skills

Auditing expertise

Stakeholder management

Regulatory knowledge

Project management

Communication

Tools

Microsoft Office

Audit tracking tools

ERP systems

Job description

Position Description

Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."

This position serves as a subject matter expert and liaison between Capital Blue Cross (Capital) internal business units, external auditors, and regulatory agencies. This role ensures successful execution of external audits, response oversight, and compliance with Capital processes and standards. The position requires deep knowledge of Capital organizational structure, claims processing systems, and operational workflows. The incumbent will independently manage complex projects, interact with senior leadership, and maintain accountability for audit deliverables and reporting.

Responsibilities and Qualifications

• Plan, organize, and lead external audit projects related to group benefit examinations and other group audits allowed by the contract, BCBSA audits, and contractual compliance reviews.
• Act as primary liaison between external auditors and Capital operational areas on all aspects of external audits.
• Track and manage audit deliverables, ensuring timely completion and accurate documentation.
• Provide training to internal parties for appropriate support in engaging with external auditors and reviewing noted audit exceptions.
• Recommend and develop department policy and procedures.
• Provide leadership to ensure Capital meets its contractual obligations with respect to existing group audit rights and compliance clauses.
• Review and coordinate with Legal on proposed changes to contractual audit rights and advise Sales and Underwriting Management on prospective changes.
• Maintain strong, collaborative relationships with external auditors and ensure adherence to Capital standards.
• Lead internal meetings, including Senior Leadership, to discuss audit-related matters.
• Demonstrate knowledge of Capital processing systems, including Pharmacy (Rx) workflows.
• Provide guidance on Capital processes and organizational structure to internal and external stakeholders.
• Oversee, coordinate, and schedule external audits, examinations, or surveys. This includes, but is not limited to, maintaining an appropriate external audit schedule balanced with existing resources, collecting and maintaining all requested documentation in compliance with Capital standards, ensuring timely completion of all external audits, and adequate/timely/professional responses from internal stakeholders.
• Monitor open and closed audit items, assign tasks, and ensure timely follow-up.
• Recommend corrective actions to operational functions and verify implementation through performance tracking.
• Communicate effectively with Capital leadership, providing updates on audit progress and compliance risks.
• Prepare and present reports for management review.

Skills:

• Deep understanding of Capital systems and processes.
• Strong negotiation skills.
• Proficient in Microsoft Office Suite and audit tracking tools, combined with analytical and problem-solving skills.
• Exceptional organizational and project management skills. Experience in planning, organizing, and managing complex cases or initiatives.
• Ability to influence and communicate effectively through written and oral communications across all levels of the organization, external auditors and account representatives, with a focus on communicating complex issues in an organized concise manner.
• Ability to establish and maintain cooperative and professional working relationships across multiple departments within Capital.
• Ability to adjust to changing priorities and manage time effectively to meet urgent deadlines.

Knowledge:

• Knowledge of Capital commercial, ancillary, and government product lines and all supporting operations sold/serviced by Capital and its associated business ventures.
• Working knowledge of departments and administrative procedures in sales, marketing, enrollment, billing, underwriting, configuration, IT, claims, customer service, clinical management, government programs, internal audit and finance processes, preferably in the health insurance industry.
• Familiarity with operational processing systems utilized throughout Capital's business o